CFS/Fibromyalgia Clinical Review - WHO IS AFFECTED BY THESE SYNDROMES?
BY JACOB E. TEITELBAUM, M.D.
Current conservative estimates are that two percent of the population (i.e. six to 12 million Americans) suffer with CFS and/or fibromyalgia. As is the case with many diseases of the immune system (e.g.-lupus), these syndromes affect 3 times as many women as men.
WHAT IS CAUSING THESE ILLNESSES?
CFS/FMS is not a single illness. Our study has shown that it is a mix of many different processes that can be triggered by many causes. Some of you had your illness caused suddenly by any of a number of infections or by an injury (sometimes very mild). In others, the illness had a more gradual onset. This may have been associated with hormonal deficiencies (e.g. low thyroid, estrogen, etc.) despite normal blood tests. In others, it may be associated with chronic stress, infections, and/or nutritional deficiencies. Indeed, we have found well over 100 causes of, and factors that contribute to these syndromes.
We suspect that CFS/Fibromyalgia acts as a circuit breaker to shut down the system before any permanent harm is done from these stresses. What these processes have in common is that most of them can suppress a major control center in your brain called the hypothalamus. This center controls sleep, your hormonal system, temperature, and blood flow/blood pressure. When you don't sleep deeply, your immune system also stops working properly and you'll be in pain. When we realized this, the myriad symptoms seen in CFS/fibromyalgia suddenly made sense. We also recognized that these illnesses may not be the enemy, but rather the body's attempt to protect itself before permanent and irreversible damage was done. It also gave us a way to effectively treat you!
The lead article in a recent edition of the Journal of Chronic Fatigue Syndrome is titled "Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia— the Results of a Randomized, Double-Blind, Placebo-Controlled Study"! In our study, 91 percent of patients improved with an average improvement in quality of life of 90 percent. Many patients no longer even qualified for the diagnosis of CFS or fibromyalgia after treatment. (See full text at: www.endfatigue.com)
In support of our work, an editorial in the April, 2002 journal of the major multidisciplinary medical society for pain management in United States noted the comprehensive and aggressive metabolic approach to treatment detailed in the Teitelbaum study are all highly successful approaches and make fibromyalgia a very treatment responsive disorder. The study by Dr. Teitelbaum et al. and years of clinical experience make this approach an excellent and powerfully effective part of the standard of practice for treatment of people who suffer from fibromyalgia.
It is important to recognize that these syndromes can be caused and aggravated by a large number of different triggers. When all these different contributing factors are looked for, and treated effectively, patients improved significantly and often get well!
FOUR MAIN CATEGORIES OF PROBLEMS NEED TO BE TREATED.
Because the western diet has been highly processed, nutritional deficiencies are a common problem. In addition, bowel infections can cause poor absorption, and the illness itself can cause increased nutritional needs. The most important nutrients include: a) vitamins—especially the B vitamins (most at 25- 50 mg/day), vitamin B12 (50-3000mcg/day), antioxidants, b) Minerals—especially magnesium, zinc, iron, and selenium and c) amino acids (proteins). There is an excellent product I've made (Daily Energy Enfusion by Enzymatic Therapy) that contains these and many more (50 nutrients in total in the proper dose) in one scoop of a powder and one capsule taken daily. This eliminates the need for 25 supplement tablets/day. It is available in health food stores or on www.endfatigue.com. As I have a policy of not taking money from any company whose products I recommend, I have instructed the company to donate 100% of my royalties to charity.
Most patients with these illnesses find that they are unable to get 7-8 hours of deep sleep a night without taking medications. In part, this occurs because hypothalamic function is critical to deep sleep. Unfortunately, many of the most common sleep medications actually aggravate the sleep problems by decreasing the amount of time spent in deep sleep. For patients to get well, it is critical that they take enough of the correct sleep therapies to get 7 to 9 hours sleep at night! These medications include Ambien, Desyrel, Flexeril and/or Elavil. In addition, natural remedies that can help sleep include valerian, piscidia, hops, passion flower, wild lettuce, theanine, lemon balm, 5- HTP, and melatonin. The first 6 of these are available in the" Revitalizing Sleep Formula" by Enzymatic Therapies. After 6-18 months of feeling well, most people can come off of most medications.
The hypothalamus is the main control center for most of the glands in your body. Most of the normal ranges for our blood tests were not developed in the context of hypothalamic suppression or these syndromes. Because of this (and for a number of other reasons) it is sometimes necessary to treat hormonal deficiencies based on the patient's symptoms. These hormones have been found to be reasonably safe when used in low doses.
Many studies have shown immune system dysfunction and a host of infections in FMS/CFS. Although there are many causes of this, I suspect that poor sleep is a major contributor. As in AIDS, the immune dysfunction can result in many unusual infections.
There are many other treatments available as well. Although space does not allow for a full discussion of these in this article, I discuss them at length in the most recent edition of my book, "From Fatigued to Fantastic" which came out August, 2001. In addition, my web site (www.endfatigue.com) has a list of over 150 different treatments with instructions, a computer program that can tailor a treatment program to your case, and an area where you can see how people voted on the different treatment's effectiveness. With appreciation for all you've been through, Jacob E Teitelbaum MD